This official request is made in accordance with Section 441(d) of the Revenue and Taxation Code. This statement must be completed according to instructions and filed with the Assessor. Failure to file this statement will authorize the Assessor to estimate the value of your property based on information in his possession pursuant to section 501, Revenue and Taxation Code. This statement is not a public document. The information contained herein will be held secret by the Assessor (Sec. 451, Rev. & Tax Code); it can be disclosed only to the district attorney, grand jury, and other agencies specified in Sec. 408 of the Rev. & Tax Code. Attached schedules are considered to be part of the statement.